Non-Sports Concussions

Regardless of age and profession, motor vehicle accidents and falls are the most common ways that people can sustain traumatic brain injuries. Even first responders – police, fire, and ambulance crews – regularly go into harm’s way and risk personal injury that includes concussions, as recently happened when two firefighters in New Jersey slipped while jumping off their fire engine at a house fire.

Even firefighters and other first responders are vulnerable to concussions (Photo: AP/Wide World)

Although sports like football, soccer, and lacrosse get a majority of the press about head traumas and traumatic brain injuries, most of the traumatic brain injuries that we see in HeadFirst Concussion clinics are due to everyday events such as slips and falls and motor vehicle accidents.

Some doctors tell me that the “concussion craze” is going to burn out soon. However, I think the way concussion specialists and medical providers diagnosis and treat traumatic brain injuries will continue to evolve. Other clinicians believe that education, evaluation and treatment of mTBIs will continue to grow in different directions.

Some considerations for the future may include:
– people who carry weapons, work with hazardous materials, or are employed in high-risk jobs could require baseline neurocognitive testing with their employment physical in the event they suffer a brain injury
– schoolchildren of all ages, including the elementary school level, may receive education, baseline testing, while training may be required for all parents and coaches about traumatic brain injuries (it is presently only required for high school kids)
– employers may insist employees to get baseline neurocognitive testing prior as a condition of employment

What we have found in HeadFirst Concussion clinics is that 60-70% of mTBIs are not sports related and more than 95% of our injured patients have not had baseline neurocognitive testing. While concussions continue to make the news and diagnosis increase as public awareness spreads, we encourage people of all ages to schedule a baseline neurocognitive test.

The topic of mild traumatic brain injury and/or concussion has been in the news for several years. The release of a major motion picture, a concussion sustained by a professional sports star, or the passage of a law tends to rekindle interest in the topic. Recently, another issue was linked to concussion — the concern of suicide. But, I am optimistic. Why? By nature, I’m an optimist, but I’m also hopeful that parents, community leaders and politicians will pay attention to the epidemic of suicide in our country.

When I worked in the U.S. Navy, one of my careers was serving as their Suicide Prevention Program Coordinator. Every death by suicide crossed my desk. The number of Marines and Sailors who attempted and completed suicide staggered me.

In our country, the number of people — servicemembers or civilian — who die by suicide is almost too much to comprehend. Compared to 16,000 homicides each year in the U.S., the number of suicides is nearly double that at almost 32,000 a year, most due to untreated depression of some form.

Let’s put those numbers in another perspective: In the last decade of our troops fighting in Afghanistan and Iraq, just over 7,000 Americans have made the ultimate sacrifice and almost 50,000 have been wounded. During that same time, more than 300,000 have died by suicide and more than 50,000 have been children between the ages of 14 and 24. The number of suicide attempts is in the millions.

Researchers are also finding out that some of the consequences of concussion are linked to depression and suicide. Untreated brain injuries can lead to devastating consequences.

My optimism lies in the hope that coaches, parents, athletes, and community leaders understand that the physiology of a concussion caused by a blow to the head or body prompts the neurons to function ineffectively due to a disruption of their normal chemical process.

I’m optimistic that these same parents, coaches, athletes, and community leaders will make the connection that the neurological process of a concussion is to depression. That these neurons which govern our emotions and self-esteem for a variety of different reasons — the death of a loved one, loss of a job, bankruptcy, medical conditions — can lead to a disruption of the neurons and cause depression leading to suicide.

I’m optimistic that the people who form every individual’s support system, from parents and teachers to friends and fellow athletes, will ACT if something seems amiss:
A — ask an individual if he or she is thinking about suicide
C — let him or her know you care about them
T — get the individual to treatment with someone who specializes in suicide evaluations: a counselor, pastor or chaplain, family doctor or pediatrician, psychologist, or psychiatrist or local emergency room

I’m optimistic that people will realize that depression can be considered the “common cold” of psychiatric conditions and has a variety of effective treatment options.

The much-anticipated movie “Concussion” is scheduled for release this year on Christmas Day, and already there is Oscar Award talk for Will Smith, who plays the role of Dr. Bennet Omalu. It was Dr. Omalu who discovered the tragic progressive degenerative effects of years of multiple concussions in NFL players, which he named CTE (chronic traumatic encephalopathy).

Bennet Omalu, M.D., (L) and actor Will Smith attend the screening of the major motion film, “Concussion,” on November 23, 2015. (VALERIE MACON/AFP/Getty Images)

The film highlights the NFL’s initial response of anger and denial. Indeed, since Dr. Omalu’s discovery in 2002, the NFL has experienced lawsuits, exposés, and finger-pointing in general. Now, 13 years later, bystanders have watched the NFL’s reaction to this scientific research unfold in a manner not unlike many stages of grief – first denial, then anger, on to bargaining and, finally, acceptance. (Although, the League is still working on fully coming to terms with this last step.)

For their part, the NFL hasn’t had much reaction to the movie, preferring to keep the controversy at arm’s length. While Dr. Omalu has vocalized his opposition to children playing football until they are legally and emotionally old enough to understand the danger of putting their brains at risk, the NFL can’t afford to lose any of their reported $7+ billion in annual revenue.

Yet, while the debate rages on, two points are patently clear from years of scientific research: that children repeatedly hitting their heads during developmental years is potentially very harmful, and that college and professional football players can face significant health consequences from playing the sport.

But just how serious are families going to be about keeping their children from playing football? Indeed, this is just the beginning of the conversation about brain injuries.

As a community-based concussion clinic that has treated more than 30,000 traumatic brain injury patients over the past three years, HeadFirst Concussion Care has seen multiple reasons for why people sustain concussions. And while football is a violent sport, soccer, lacrosse and hockey also put our youth at risk for head trauma.

And again, this is just half of the dialogue. HeadFirst’s data shows that traumatic brain injuries sustained while playing organized sports with a concussion protocol in place (high school or college sports) account for a relatively small percentage of our patients. In fact, in as many as 80 percent of our patients, concussions are sustained by other mechanisms of injury. These include non-organized sports-related injuries (bike riding, skateboarding, trampolining, skiing, pick-up or other informal recreational games), slips and falls, motor vehicle accidents, and assaults.

The key message is that the people must understand that traumatic brain injuries can happen to anyone, anywhere, at any time. Not just kids. Not just athletes. And certainly, not just NFL players. And since anyone is at risk, everyone must understand the proper protocols for healing an injured brain.

On a final note to end the year, my holiday wish is that families, schools, and employers begin to talk about head injuries and follow traumatic brain injury protocols to keep all children and adults safe.

Each week in our concussion clinics, I am reminded about how seemly innocuous summertime activities can unexpectedly take a turn for the worse. Pool injuries are all too common, especially in older teens and young adults. Though their bodies have changed over the years, people in the late teens and early 20s can forget how much taller they are and more they weigh than in their youth.

I recently saw a young women who had jumped into about four feet of water and landed on her head and neck. She needed to be flown out to a regional hospital that manages shock and trauma patients but, luckily, had no life-threatening injuries. Unfortunately, the hospital sent the patient home with instructions to wake up every couple of hours, which goes against concussion recovery guidelines for brain rest. So, our work on educating both the public and professionals goes on.

Another patient I recently treated was a man in his 60s who was playing baseball with his grandson and fell face-first against a tree — hard enough to sustain an eye injury and a concussion. After more than a year of treatment, he continues to have memory and balance problems.

The summer is a fantastic time to hang out by the water, play games in the yard. But, always be careful. Be aware of your surroundings. Frequently stay hydrated and make sure your loved ones around you are doing the same.

The DVBIC website has a ton of information for servicemembers, veterans and medical providers as well as family members and friends of anyone recovering from a brain injury. All the details can be found at: dvbic.dcoe.mil.

These are just two examples of the tons of information that both the scientific community & medical providers, as well as patients and their caretakers, will find useful and educational regardless of your level of understanding of mTBI. Enjoy & I hope you all had a fantastic 4th of July.

Basic physics teaches us that an object at rest will always remain at rest unless acted on by an unbalanced force. Likewise, an object in motion will continue in motion with the same speed and in the same direction unless acted upon by an unbalanced force. We humans are objects that seem to always be always in motion, so it stands to reason that we’re continually acted upon by external forces that change our direction. Unfortunately, the direction that these forces sometimes push us coincides with another of Newton’s Laws: Gravity.

Slips and falls are one of the top causes of unintentional injuries in the United States, accounting for approximately 8.9 million visits to the emergency department annually (National Safety Council Injury Facts 2011). When we fall, it always seems like we fall head first. Falling out of bed, slipping in the bath, falling down steps, and falling from ladders accounts for a large percentage of head traumas, some of which can result in Mild Traumatic Brain Injuries (MTBI).

Since becoming an object perpetually at rest is not an option lowering the impact of these unbalanced forces is the only way we can prevent these traumatic injuries from occurring. Fortunately with spring in the air now is a good time clean up our homes (where most of these injuries occur) to prevent these injuries from happening.

Here are some home safety tips to help prevent injuries and falls:

o Clean up all spills immediately

o Stay off freshly mopped floors

o Secure electrical and phone cords out of traffic areas

o Remove small throw rugs or use non-skid mats to keep them from slipping

See, we were hoping you’d see this as an ideal way to reach all your fans, warning them of the dangers of concussions, even though the incident might have seemed like an insignificant injury to you.

But no, you and your manager both succeeded in sweeping the situation under the proverbial rug.

Here are some tidbits from your tweets, along with our commentary about the facts:

“im fine. just smacked my head”
No, a concussion is more than smacking your head. It’s when your brain gets knocked against the inside of your skull.

“needed some water. all good.”
No, Biebs, a concussion is not the same as dehydration.

“jb is gonna be fine. things happen. he is a trooper. canadian hockey player. tough kid. no issue.”
No, JB’s manager, concussions are serious issues, and they have nothing to do with being tough. Even the toughest of the tough have been sidelined by concussions, and that includes Canadian hockey players.

Oh, and by the way, the fact that you’ve been on Twitter since your concussion has not escaped us. Part of allowing your brain to rest is staying away from computers, cell phones, video games and the like. Yes, that includes dancing around. Not fun but very important.

So, Justin, please know that concussions are no small matter and we appeal to you to tell your fans the facts.

In the meantime, we have some advice for you: When In Doubt, Sit It Out. And watch those doors.